Concussion Healing

Lots of myths and misinformation exist about how parents and coaches can supervise the recovery of a child’s concussion. Some of the most common ones stem from advice that was given years ago. But better understanding of brain injuries and new imaging technology has changed how concussions are treated. Here’s what NOT to do when managing your child’s injury.

1 — Waking Every Hour or Two
Decades ago, physicians and clinicians encouraged parents to wake up their concussed children frequently to monitor their mental status. However, with modern imaging and clinical evaluations, patients who have been cleared by a concussion specialist can sleep soundly. In fact, remaining asleep 12, 15 or even 20 hours following a head injury is actually helpful, restful, and promotes faster recovery.

2 — Return to the Game Too Soon
Most concussion laws in every state have a provision in which a child is removed from play when a concussion is suspected and can only be cleared to return by a concussion specialist. Unfortunately, clinicians will periodically encounter an overly ambitious parent wanting to return his or her child to play prior to making a full recovery from the concussion. Depending on the timing, this can be exceedingly dangerous. If it is too soon, the child may be in danger of secondary impact syndrome, which can be fatal.

3 — Keep Away from Friends and Electronic Devices
Socialization is an important part of adolescent development. Keeping a child completely isolated from friends and electronic devices can lead to a sense of isolation, and in some cases, even depression. Clinicians and parents need to be mindful of balancing remediation with a young person’s sensitive self-esteem.

4 — Promote Completely Inactivity and Darkened Rooms
Although some rest is thought to be useful from 48 to 72 hours after the head injury, extensive rest and inactivity in a dark room is actually thought to do more harm than good. The brain can actually have more difficulty to returning to normal activity following an extensive period of inactivity.

A number of research articles suggest that women are more susceptible to mild Traumatic Brain Injury. In fact, female college athletes have a higher rate of concussion compared to males when playing soccer (2.1 x greater risk), softball versus baseball (up to 3.2 x greater risk), and basketball (up to 1.7 x greater risk). So, why the difference? Research and anecdotal evidence has turned up three possible reasons: cultural differences; hormonal differences, or physiological differences.

Canada forward Christine Sinclair (right) and USA midfielder Carli Lloyd head the ball during the 2016 CONCACAF women’s Olympic soccer tournament at BBVA Compass Stadium in Huston, Texas, on February 21. Soccer is also among those sports programs that produce a large share of concussions for female athletes. — Reuters

Some experts have said part of the reason for increased concussions in females may be due to the reporting rate — that women are more likely than men to notify a coach they are injured, whether due to a head injury or other concern. Cultural differences indeed indicate a reluctance among males to report any injuries for fear of being removed from play. However, because of the very nature of concussion being a clinical diagnosis that usually depends on self reporting, it is hard to say that the incidence differences between the genders is due to honesty.

Other research suggests that hormones including estrogen, oxytocin, progesterone, and testosterone, affect recovery times from concussion. Of course, men and women have vastly differing levels of these hormones. One published study from the University of Rochester (NY) has also shown that menstrual cycles play a part in healing from head trauma. The research showed that women in child-bearing years experience greater cognitive decline, delayed reaction times, extended periods of depression, more headaches, and longer hospital stays and return-to-work plans compared to men following head injury.

Other research suggest that there are different neuronal connections between the hemispheres and significant lobes within the cerebral cortex for men and women potentially influencing recovery time. A recent Georgetown University Medical Center study showed that mice with a single head injury temporarily lose 10 to 15 percent of the neuronal connections in their brains, which can be repaired when at least a week of rest is provided. The fact that male and female brains are “wired” differently could account for a higher incidence of and/or a longer healing period after brain injury in women.

Realistically, interplay of all of these factors could potentially influence the differences in concussions between the number of concussions of female athletes and their recovery.

A recent study published in American Academy of Pediatrics June 2015 Pediatrics (published online on May 11, 2015) looked at concussion and its effect on academic performance. The research included a sample of 349 students, ages 5 to 18, who sustained a concussion and whose parents reported post-injury academic concerns on school questionnaires. The type and intensity of the students’ concussion symptoms were measured as an indicator of the severity of their injury.

Researchers found that actively symptomatic students and their parents had heightened concerns over the effects of the students’ concussions on their school performance, as well as increased school-related problems than their recovered peers. In other words, the students’ level of post-concussion symptoms had a direct relationship to the extent of academic effects.

Eighty-eight percent of students with symptoms reported school problems due to headaches, fatigue and concentration issues, while 77 percent reported issues such as needing to spend more time on homework, difficulty taking notes, and studying.

Additionally, high school students in the study who had not yet recovered reported significantly more adverse academic effects than their younger counterparts. The greater the severity of their concussion symptoms was also associated with more school-related problems and worse academic effects, regardless of time since injury.

Every state has concussion legislation generally requiring three basic criteria in the event of a concussion:

The removal of a child from play

A structured return to learn

Clearance from a concussion specialist

However, most youth aren’t athletic professionals and many of them do not advance to participate in college and professional athletics. Currently, only Nebraska and Virginia have return-to-learn legislation indicating that concussed athletes may need specific informal or formal accommodations at school and that school personnel should be trained in concussions. In light of students’ limited number of years of sports and because of recent proven research, legislation should be in place in every state to provide more extensive accommodations after a brain injury so that students’ academics are not adversely affected.

Authors examined the difference between the outcomes of two groups of children (average age of 13-14 years old) who presented within 24 hours of a head injury to an emergency room. Half were told to rest for as long as needed, usually for 1-2 days, followed by stepwise return to the usual level of activity. The other half was told to rest for 5 days, without engaging in any school or work engagements, followed by stepwise return to activity. Participants had neurocognitive (ImPACT) and balance assessments at baseline and at their follow-up visits at 3 and 10 days. They also kept a diary of their activity level and how they felt.

In both groups, 60% of participants reported resolution of their symptoms. However, half of the “strict rest group” took 3 additional days to reach a full recovery. This strict rest group also tended to have a larger amount of emotional issues, as they were kept away from school and social settings. Children in the strict rest group who had headaches at the onset of their concussion tended to have lingering symptoms for a longer period of time than the control group. The one exception to better outcomes in the control group was for children who had immediate loss of consciousness or amnesia at the time of their injury. These children seemed to benefit from 5 days of strict brain rest.

In general, it appears that not all children who experience a mild TBI should receive a prescription for strict 5-day brain rest. There may be benefits in treating each patient individually, depending on their initial symptoms, level of cognitive function, and severity of concussion. Some may need no rest, some may need 1-2 days of rest, and yet others may need 5 or more days of avoiding demanding brain stimulation. More studies are needed before the current guidelines can change. The one recommendation that is gaining more support in recent years is to have patients engage in exercise early in their post-concussive period. Increasing physical activity tends to do wonders for rehabilitation of patients who suffer from a stroke (which is a vascular brain injury) and it may be just as beneficial for kids or adults who have had a traumatic brain injury.

For now, if you have had a brain injury, please be sure to see your doctor or a sports medicine specialist who is familiar with concussion management issues. Your brain is a precious organ and it’s important to work with experts in the field on controlling your symptoms and finding the best resolution for full recovery. Otherwise you may end up having lingering post-concussive symptoms for months, years, or decades.

Even a relatively minor head trauma can result in physical, cognitive, behavioral, and social consequences for a young patient. Specific effects of mild brain injury or concussion on language ability can include effects on the ability to think of the names for things, make sentences, and interact with others appropriately in social situations. Many studies have linked brain injury to difficulty reading and telling stories.

Anomia, or difficulty thinking of the names for objects or people (essentially, severe “tip-of-the-tongue” experiences), is the most common reported symptom that affects language. Problems with naming can have big impacts in the classroom. Imagine not being able to come up with the name of the main character in a novel or the particular term you need to name in your science class!

Not only is the accuracy of coming up with the names of objects affected (e.g., saying “dog” when viewing a picture of a dog), but also there is an increase in the time that it takes the patient to come up with the name.

This can be imagined by analogy to a computer connecting to the Internet that may eventually load a webpage correctly, but the connection is much slower than usual.

Examining differences in the “processing time” required to name an object may be useful in better understanding the cognitive changes that occur during the period of spontaneous recovery directly following a brain injury.

Researchers at the University of Maryland, College Park, are examining naming accuracy and processing time across the period of spontaneous
recovery from mild head trauma, in order to better understand the changes in young people with brain injuries.

Patients at HeadFirst Concussion Care between the ages of 10 to 20 years of age are being recruited to name rapidly presented images on a computer that measures how quickly they say the name of that image. It is predicted that adolescents with concussions will demonstrate a steep rate of recovery of naming accuracy to within normal range, with a slower recovery of processing time beyond that point.

It is our hope that this information will improve information available to clinicians and patients in making return-to-learning and return-to-play decisions and will add to what is known about how a minor injury may impact performance in language or in education.

Melissa D. Stockbridge is an M.A./Ph.D. student at the University of Maryland’s Department of Hearing and Speech Sciences

The DVBIC website has a ton of information for servicemembers, veterans and medical providers as well as family members and friends of anyone recovering from a brain injury. All the details can be found at: dvbic.dcoe.mil.

These are just two examples of the tons of information that both the scientific community & medical providers, as well as patients and their caretakers, will find useful and educational regardless of your level of understanding of mTBI. Enjoy & I hope you all had a fantastic 4th of July.

No matter the type or severity of an injury or illness, the basics of healing are the same: A good night’s sleep, a warm bowl of chicken soup, a walk in crisp, clean air, and a cup of tea can heal all your troubles…or so, Grandma used to say. Well, Grandma now has some science to back her up, even when it comes to recovering from a concussion.

Your Brain Needs Time to RestThe National Sleep Foundation recommends that adults get seven to nine hours of sleep per night for optimal mental health. The brain needs this time to perform the necessary function of memory consolidation and other essential processing. Without this, one’s mental faculties suffer. While healing from a brain injury, your brain needs more rest to perform these essential functions as well as promoting further healing from the injury. This increase in sleep is only recommended for the few days after the injury. Beyond this, a return to a normal sleep pattern is recommended to allow the body to adjust back to the normal circadian rhythm.

Feed Your Body Well for a Balanced MindThe human body relies on healthy foods for optimal functioning, growth and healing. A regular diet rich in nutrients not only fuels the body for daily activity, but also it fuels the brain. Daily intake of good foods can also avert long-term problems with depression and anxiety that can arise with a prolonged injury. Colorful fruits and vegetables that are high in antioxidants are also especially good for strengthening blood vessel walls, including those in your brain.

Regular Exercise Promotes Faster HealingRegular exercise boosts your good cholesterol and reduces your bad cholesterol, both of which keep your blood flowing smoothly and promote healing. Light exercise or therapy after an injury helps reduce pain, increase range of motion, and rebuild healthy muscle tissue. Gentle exercise after a concussion also elevates your brain’s secretion of serotonin, which can make you feel happier and more relaxed. This acts as a natural combatant against post-injury depression and anxiety.

Water is the Source of Life
Proper hydration helps all body process to function properly. Without it your body cannot begin the process of healing. Clear, nonalcoholic and non-caffeinated drinks are best. For variety, add a squeeze of lemon or lime, or drink seltzer water. There is no magic number for the amount of water to consume but don’t wait until you’re thirsty — at that point, you’ll already be on the the way to dehydration.

While a concussion is a complicated injury, healing from it doesn’t have to be. Taking steps that include rest, nutrition, hydration and gentle movement will help heal your brain faster. With all the complexities of medicine it’s nice to know sometimes simple is best.